Positive Coping Skills For Elderly Residents

FOR SOME PEOPLE OLDER ADULTHOOD IS LIKE LIVING IN A DISMAL swamp--their existence is a plummet into a stagnant, murky region with no rays of happiness to penetrate the uneasy quiescence of their lives. However, others envision 65 as the pinnacle of existence and are satisfied with living beyond that age in an oasis of tranquility.

The latter group of elderly people will have fewer problems living in a long-term care facility and may be less affected by communication disorders, researchers have found.

"I've seen people with significant aphasia communicate beautifully and people with very mild aphasia not communicate well at all," said Barbara Mastriano, PhD, CCC-SLP, associate professor in the Communication Sciences Department at Temple University, in Philadelphia, PA. "It's more than just the tools for communication that people have; it's some other issue."

Effective communication among residents in long-term care facilities depends on several issues, she said, including cognitive status, attitudes of staff members, and support both inside and outside of the facility.

Theorizing that a positive outlook and satisfactory communication are related to life coping strategies, Dr. Mastriano interviewed 43 people living in two Philadelphia nursing homes. The subjects were between the ages of 65 and 103, with 44 percent over the age of 85.

She excluded people with dementia but included individuals with communication problems. Demographic variables, such as gender and education, also were factored out.

Dr. Mastriano talked with each subject individually for three to four hours. Using the Ways of Coping Questionaire, by Richard Lazarus and Susan Folkman, she determined what coping strategies each individual used in daily life when confronted with a stressful situtation. For the residents interviewed, the stressful situation was loss independence. Responses showed either a change in attitude toward the situation or an attempt to avoid it in some way.

When an individual tried to "escape" the situation, she found this coping strategy correlated significantly with high levels of depression, while people who dealt directly with the issue and changed their personal definition of independence had mild or no depression.

"A sense of positive well-being is the key issue to one's ability to reside comfortably in the nursing home setting," said Dr. Mastriano.

To show how positive coping strategies can perpetuate a sense of well-being, the speech-language pathologist cited the late Gray Panther leader Maggie Kuhn, who founded the national organization that works to advocate issues concerning the elderly. As Kuhn aged, the once independent woman became frail. Though she was not institutionalized, she had to depend on other people to help her.

"Kuhn reconciled that by saying, 'I may be dependent physically, but I still think independently,'" said Dr. Mastriano. "She redefined what independence meant. This is seen as a positive coping strategy by the tool."

People in nursing homes also benefit from positive coping tools, the researcher found. One subject had a physical disability and experienced trouble getting in and out of wheelchairs because of her size. In addition, the woman was dismayed by peers who complained a lot when they gathered in the day room of the facility. While her coping strategy was to stay in her room, she did not suffer from isolation. The woman was content with this arrangement and had family and staff members who she enjoyed talking with to visit her.

Though many of the elderly people in the survey didn't communicate a lot, Dr. Mastriano encountered others who were very social. People in small enclaves of interaction had no problem initiating conversation.

"Despite disability, some people in an institution generally seem to do well in terms of social communication, as they define doing well," she said.

Subjects indicated that redefining one's comfort zone at different stages of life is valuable in order to have realistic perceptions about themselves, she found. "Even as I was talking to one woman, I could see that she was redefining what made her feel satisfied."

Redefining happiness, rather than simply compromising in accordance with their current abilities, also enables elderly individuals to have a better self-image, Dr. Mastriano said.

However, "striving for autonomy--to be in control of one's life--doesn't change," she explained. "How one defines a sense of well-being is very personal. You see it in the 2-year-old that says 'no' to everything. How you define autonomy and independence changes for those who continue to have a positive sense of well-being."

This may explain why people who referred themselves to a nursing home seemed to have a more positive outlook than those who were admitted by their families against their wishes, the clinician said. People who did not refer themselves to a long-term care facility were denied the opportunity to make this decision for themselves, which diminished their autonomy.

Another area that seems to influence positive self-image is spirituality. Dr. Mastriano found that people used a self-defined sense of spirituality as a coping strategy in adjusting to living in a nursing home.

One of the nursing homes in her survey was primarily African-American and had been started by a Baptist church many years ago, said Dr. Mastriano. The other home had no religious affiliation, but the majority of its residents were Jewish. Neither required the residents to participate in religious activities, but services were provided for those who were interested.

Many participants from both nursing homes didn't report adherence to a particular religion, but they used words such as "God," "spirit" and "life" to describe the spiritual reverence they felt. Dr. Mastriano found that those who had some level of spirituality used this sense as a strategy and that this strategy had a significant sense of well-being.

Fostering or preserving a positive self-image among elderly individuals is vital to maintaining effective social skills, the researcher concluded. This can be done by guiding them in redefining their attitude toward themselves.

"Helping residents appreciate who they used to be as well as who they are now is an important variable," said Dr. Mastriano.

Training staff and developing strategies for residents to achieve interdependence rather than dependence also is useful, as is providing them with avenues by which they can take control over decision-making.

Speech-language pathologists can help initiate programs in nursing homes that not only foster communication but help senior citizens utilize their skills. For instance, while an elderly person who was once a skilled knitter may be unable to knit due to severe arthritis, the person can instruct others. Not only does this create an arena for communication, it grants the pleasure of participating in something the person enjoys, which reinforces a positive self-image.

"There could be more tapping into the resources of the residents and what skills they have in creative ways," said Dr. Mastriano.

Cultivating such instructional communication is one way to start, she noted. Speech-language pathologists then can set up similar programs that will provide avenues for social communication.

When an individual tried to "escape" the situation, she found this coping strategy correlated significantly with high levels of depression, while people who dealt directly with the issue and changed their personal definition of independence had mild or no depression.

"A sense of positive well-being is the key issue to one's ability to reside comfortably in the nursing home setting," said Dr. Mastriano.

To show how positive coping strategies can perpetuate a sense of well-being, the speech-language pathologist cited the late Gray Panther leader Maggie Kuhn, who founded the national organization that works to advocate issues concerning the elderly. As Kuhn aged, the once independent woman became frail. Though she was not institutionalized, she had to depend on other people to help her.

"Kuhn reconciled that by saying, 'I may be dependent physically, but I still think independently,'" said Dr. Mastriano. "She redefined what independence meant. This is seen as a positive coping strategy by the tool."

People in nursing homes also benefit from positive coping tools, the researcher found. One subject had a physical disability and experienced trouble getting in and out of wheelchairs because of her size. In addition, the woman was dismayed by peers who complained a lot when they gathered in the day room of the facility. While her coping strategy was to stay in her room, she did not suffer from isolation. The woman was content with this arrangement and had family and staff members who she enjoyed talking with to visit her.

Though many of the elderly people in the survey didn't communicate a lot, Dr. Mastriano encountered others who were very social. People in small enclaves of interaction had no problem initiating conversation.

"Despite disability, some people in an institution generally seem to do well in terms of social communication, as they define doing well," she said.

Subjects indicated that redefining one's comfort zone at different stages of life is valuable in order to have realistic perceptions about themselves, she found. "Even as I was talking to one woman, I could see that she was redefining what made her feel satisfied."

Redefining happiness, rather than simply compromising in accordance with their current abilities, also enables elderly individuals to have a better self-image, Dr. Mastriano said.

However, "striving for autonomy--to be in control of one's life--doesn't change," she explained. "How one defines a sense of well-being is very personal. You see it in the 2-year-old that says 'no' to everything. How you define autonomy and independence changes for those who continue to have a positive sense of well-being."

This may explain why people who referred themselves to a nursing home seemed to have a more positive outlook than those who were admitted by their families against their wishes, the clinician said. People who did not refer themselves to a long-term care facility were denied the opportunity to make this decision for themselves, which diminished their autonomy.

Another area that seems to influence positive self-image is spirituality. Dr. Mastriano found that people used a self-defined sense of spirituality as a coping strategy in adjusting to living in a nursing home.

One of the nursing homes in her survey was primarily African-American and had been started by a Baptist church many years ago, said Dr. Mastriano. The other home had no religious affiliation, but the majority of its residents were Jewish. Neither required the residents to participate in religious activities, but services were provided for those who were interested.

Many participants from both nursing homes didn't report adherence to a particular religion, but they used words such as "God," "spirit" and "life" to describe the spiritual reverence they felt. Dr. Mastriano found that those who had some level of spirituality used this sense as a strategy and that this strategy had a significant sense of well-being.

Fostering or preserving a positive self-image among elderly individuals is vital to maintaining effective social skills, the researcher concluded. This can be done by guiding them in redefining their attitude toward themselves.

"Helping residents appreciate who they used to be as well as who they are now is an important variable," said Dr. Mastriano.

Training staff and developing strategies for residents to achieve interdependence rather than dependence also is useful, as is providing them with avenues by which they can take control over decision-making.

Speech-language pathologists can help initiate programs in nursing homes that not only foster communication but help senior citizens utilize their skills. For instance, while an elderly person who was once a skilled knitter may be unable to knit due to severe arthritis, the person can instruct others. Not only does this create an arena for communication, it grants the pleasure of participating in something the person enjoys, which reinforces a positive self-image.

"There could be more tapping into the resources of the residents and what skills they have in creative ways," said Dr. Mastriano.

Cultivating such instructional communication is one way to start, she noted. Speech-language pathologists then can set up similar programs that will provide avenues for social communication.

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